There are approximately 219 skilled nursing facilities (SNF) enrolled as providers with the Alabama Medicaid Agency.
The Quality Assurance/Reimbursement Unit of the Provider Audit Division of the Alabama Medicaid Agency is responsible for performing desk audits of SNF cost reports to verify accuracy, detect obvious unallowable costs, and remove unallowable costs prior to computing per diem rates.
The unit also calculates recoupments/payments resulting from field audits and maintains Agency SNF provider privilege assessment records.
Click here to learn more about Medicaid coverage for people eligible for nursing home care.
Rule No. 560-X-22-.23. Cost Reports
Each provider is required to file a complete uniform cost report for each fiscal year ending June 30. The complete uniform cost report must actually be received by Medicaid on or before September 15.
Should September 15 fall on a state holiday or weekend, the complete uniform cost report will be due the following work day.
Extensions may be granted only upon written approval by Medicaid for good cause shown. An extension request must be in writing, contain the reasons for the extension, and must be made prior to the cost report due date.
Only one extension per cost reporting year will be granted by the Agency. Extensions in excess of thirty (30) days will not be granted.
Rule No. 560-X-22-.05. Medicaid Per Diem Rate Computation
The rates will be based on the cost data contained in cost reports (normally covering the period July 1 through June 30).
In order to allow adequate time for a provider to prepare and submit the cost report and for Medicaid to compute a new rate, each provider will be paid an interim per diem rate.
This interim rate will cover the period July 1 through December 31. The interim rate shall be the lower of the latest allowable computed rate or the ceiling rate per day. The allowable rate per day shall be trended by the Alabama Medicaid trend factor (See Rule No. 560-X-22-.07(4)).
Providers will be paid a weighted per diem rate for the portion of the fiscal year remaining after the provider's new rates are established.
Rule No. 560-X-22-.15. Change in Ownership (CHOW)
Providers who terminate their participation in the Medicaid Program must provide a final cost report within seventy-five (75) days of terminating their participation in the program.
Failure to file this final cost report will result in Medicaid treating all reimbursement for the period covered by the cost report as an overpayment.
New owners must choose, in writing, to:
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Accept the terminating owners’ per diem rate, or
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Submit a six-month budget cost report which will be used to set a budget per diem rate that will be settled after actual costs for the same six-month period have been received.
Program Authorities
Contact Information
Email: ProviderAudit@medicaid.alabama.gov
Gainwell Provider Assistance Center